Neonatal sepsis in Sakaeo Crown Prince Hospital.

Abstract

Objectives : To analyze the culture-proven neonatal sepsis with regard to the incidence,mortality rate, clinical manifestations, risk factors, causative bacterial organisms and their antimicrobial susceptibility patterns.

Method : A retrospective review was conducted on data from the medical charts of all neonates, who had culture-proven sepsis and were admitted to either neonatal or intensive care unit from April 2005 to December 2007. The patients were divided into early-onset (EOS) and late-onset (LOS) groups, with clinical sepsis occurring within the first 3 days of life and after the third day of life respectively.

Result : Of 7065 live-born neonates, 27 had culture-proven sepsis, giving the incidence of 3.8 per 1000 live births. The common clinical manifestations, in order of decreasing frequency, were hyperthermia (70.4 percent), lethargy (44.4 percent),jaundice (44.4 percent), and respiratory distress (37 percent). When compared with the EOS, LOS was more likely to occur in VLBW neonates (40.0 percent vs 5.9 percent; p = 0.047), developed more hyperglycemic (50.0 percent vs 5.9 percent; p = 0.015) and thrombocytopenic (80.0 percent vs 11.8 percent,p = 0.001) episodes. The significant risk factors related to sepsis were preterm (51.9 percent), mother receiving steroid before delivery (37.0 percent), and VLBW neonate (18.5 percent). The frequent organisms isolated in EOS were Streptococcus viridans (23.5 percent) and Escherichia coli (17.6 percent), but as for LOS, they were Klebsiella pneumoniae (54.5 percent) and Citrobacter freundii (18.3 percent). Streptococcus viridans were 100 percent sensitive to penicillin and 3rd generation cephalosporin. Staphylococcal aureus were also 100 percent sensitive to oxacillin. So were gram-negative organisms to amikacin and meropenam. The mortality rate was 0.56 per 1000 live births.

Conclusion : In individual institute, early detection of sepsis in neonates having risk factors,together with knowing beforehand the predominant causative organisms and their antimicrobial susceptibility patterns are of great value in the reduction of morbidity and mortality, especially in preterms and VLBW neonates.